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5 healthy habits at middle age may mean up to 9 extra years free of chronic disease

Maintaining five healthy habits – eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking – at middle-age may increase years lived free of type 2 diabetes, cardiovascular disease, and cancer, according to a study led by Harvard TH Chan School of Public Health. It is a follow-up and extension of a 2018 study, which found that following these habits increased overall life expectancy.

“Previous studies have found that following a healthy lifestyle improves overall life expectancy and reduces risk of chronic diseases such as diabetes, cardiovascular disease, and cancer, but few studies have looked at the effects of lifestyle factors on life expectancy free from such diseases,” said first author Yanping Li, senior research scientist in the department of nutrition. “This study provides strong evidence that following a healthy lifestyle can substantially extend the years a person lives disease-free.”

The researchers looked at 34 years of data from 73,196 women and 28 years of data from 38,366 men participating in, respectively, the Nurses’ Health Study and the Health Professionals Follow-up Study. Healthy diet was defined as a high score on the Alternate Healthy Eating Index; regular exercise as at least 30 minutes per day of moderate to vigorous activity; healthy weight as a body mass index of 18.5-24.9 kg/m2; and moderate alcohol intake as up to one serving per day for women and up to two for men.

They found that women who practiced four or five of the healthy habits at age 50 lived an average of 34.4 more years free of diabetes, cardiovascular diseases, and cancer, compared to 23.7 healthy years among women who practiced none of these healthy habits. Men practicing four or five healthy habits at age 50 lived 31.1 years free of chronic disease, compared to 23.5 years among men who practiced none. Men who were current heavy smokers, and men and women with obesity, had the lowest disease-free life expectancy.

“Given the high cost of chronic disease treatment, public policies to promote a healthy lifestyle by improving food and physical environments would help to reduce health care costs and improve quality of life,” said senior author Dr Frank Hu, Fredrick J Stare professor of nutrition and epidemiology and chair, department of nutrition.

Dr Kate Allen, executive director of science and public affairs at the World Cancer Research Fund, said in a report in The Guardian: “This new, large study further confirms our own research that having a healthy lifestyle lowers your risk of cancer and other diseases.

“We hope the government will be persuaded by the mounting evidence, and take bold, positive steps to protect the nation’s health by making our environments healthier, so that it is easier for people to make healthy choices.

“This includes a 9pm watershed on junk food advertising, subsidies on healthy food to make them more affordable, and better urban design that encourages walking and cycling over driving.”

Professor Jonathan Valabhji, clinical director for diabetes and obesity for the National Health Service (NHS), said: “Expanding waistlines are damaging for both the health of the nation and the NHS – leading to a string of dangerous diseases with a heavy cost for taxpayers.”

Abstract
Objective: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.
Design: Prospective cohort study.
Setting and participants: The Nurses’ Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).
Main exposures: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).
Main outcome: Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50.
Conclusion: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

Authors
Yanping Li, Josje Schoufour, Dong D Wang, Klodian Dhana, An Pan, Xiaoran Liu, Mingyang Song, Gang Liu, Hyun Joon Shin, Qi Sun, Laila Al-Shaar, Molin Wang, Eric B Rimm, Ellen Hertzmark, Meir J Stampfer, Walter C Willett, Oscar H Franco, Frank B Hu

[link url="https://www.hsph.harvard.edu/news/press-releases/healthy-lifestyle-in-middle-age-increases-years-free-of-chronic-diseases/"]Harvard TH Chan School of Public Health material[/link]

[link url="https://www.bmj.com/content/368/bmj.l6669"]BMJ abstract[/link]

[link url="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207481/"]Circulation abstract 2018[/link]

[link url="https://www.theguardian.com/society/2020/jan/08/healthy-habits-extend-disease-free-life-by-up-to-a-decade"]The Guardian report[/link]

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